Fistula Campaigns-Are They of Any Benefit?

Objective Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa) Materials and Methods Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary According to their clinical condition, women were informed and surgical options offered as appropriate Operations were performed under spinal or epidural anesthesia Immediate postoperative outcomes were followed during the stay of the surgical team in the country Results A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula In 9 8% of the women, severe local infection precluding any surgical intervention was evident In 58 8% of patients, the trigonal region and/or urethra were irreversibly damaged A proportion of patients (9 8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention Of the women that were operated on (21 6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino vaginal approach Conclusion It is extremely difficult to meet the needs of this global problem with short term programs and volunteers Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal [Taiwan J Obstet Gynecol 2010,49(3) 291-296

The Use of Human Epididymis 4 and Cancer Antigen 125 Tumor Markers in the Benign or Malignant Differential Diagnosis of Pelvic or Adnexal Masses

Background: Ovarian cancer is one of the highest mortality cancers in gynaecology. Discrimination of benign masses from malignant ones may sometimes become a challenge for the clinician since there is not a reliable tumour marker, thus some unnecessary, highly morbid operations can be performed. Aims: To explore the efficacy of human epididymis 4 (HE 4) and cancer antigen 125 (CA 125) markers in differentiating malignant and benign pelvic masses of ovarian origin and to identify the cut-off points for those markers. Study Design: Prospective study. Methods: Fifty-one patients who were diagnosed and planned to undergo surgery for ovarian mass between June 2008 and December 2008 were enrolled into this study. Preoperative venous blood samples were taken and frozen for marker investigation and final diagnoses were concluded by histopathological examination. After recruitment of all cases CA 125 and HE 4 levels were evaluated. Results: The statistical analysis did not indicate any statistically significant difference between the CA 125 levels of the patients with malignant and benign adnexal masses (p=0.105). The HE 4 levels of the patients with malignant adnexal masses were higher at a statistically significant level compared to the patients with benign adnexal masses (p=0.002). For HE 4 tumour marker and at the cut-off point of >25 pM, sensitivity was 1, specificity 0.40, positive cut-off value 0.19, negative cut-off value 1, accuracy 0.47 and positive likelihood ratio 1.65. Conclusion: Human epididymis 4 is a better diagnostic tool than CA 125 in benign-malignant discrimination of adnexal masses. The cut-off value of 25 pmol/L for human epididymis 4 will contribute to providing proper guidance to patients with adnexal masses and applying the proper treatment method

Extragenital Müllerian Adenosarcoma in the Pouch of Douglas

Background: Extragenital Müllerian adenosarcomas are extremely rare tumours characterised by a stromal component of low-grade malignancy and by a benign glandular epithelial component. Case Report: A 26-year-old woman was admitted to our clinic because of lower abdominal distension and left lower quadrant pain. Clinical and radiological examinations suggested an ovarian malignancy. Laparotomy revealed a cystic mass in the pouch of Douglas, originating from the left sacrouterine ligament. A total excision of the tumour was performed and showed low-grade adenosarcoma without sarcomatous overgrowth. Follow-up at 24 months after the surgery showed no evidence of recurrence. Conclusion: Mullerian adenosarcoma located in the pouch of Douglas is rare. For treatment, success may be achieved with only excision of the tumour if there is no sarcomatous overgrowth or spread to adjacent tissues

The Comparison of Diagnostic Modalities in Patients with Postmenopausal Uterine Bleeding

OBJECTIVE: To investigate the diagnostic values of dilatation and curettage, transvaginal sonography, sonohysterography and hysteroscopy in diagnosing the intracavitary pathologies in women with postmenopausal bleeding. STUDY DESIGN: 30 women diagnosed as postmenopausal bleeding were included into the study. All patients underwent transvaginal sonography and sonohysterography as primary evaluation; hysteroscopy and dilatation and curettage were performed immediately in seven days after primary evaluation. RESULTS: No woman with an endometrial thickness of ≤ 5mm was diagnosed as having endometrial cancer. In women with an endometrial thickness of ≤ 5mm, transvaginal sonography showed a sensitivity 100%, specificity 48%, positive predictive value (PPV) 18% and negative predictive value (NPV) 100% in detecting neoplastic changes. The sensitivity, specificity, PPV, NPV and accuracy of sonohysterography for detecting all endometrial pathologies were 100%, 73%, 54%, 100% and 80% respectively. These findings for hysteroscopy were 100%, 78%, 58%, 100% and 83% respectively. CONCLUSION: Transvaginal sonography as the primary tool in diagnosing postmenopausal lesions should be supported with sonohysterography. Patients with focal intracavitary lesion diagnosed on sonohysterography should undergone hysteroscopic evaluation enabling direct visualization and sampling of the endometrial cavity as the gold standard